With approximately 50 bookings and discharges occurring daily in King County’s adult jails, the transition from incarceration back into the community can happen quickly, often leaving people with little time to arrange medical care, addiction treatment or other services needed to rebuild their lives.
King County is taking a new approach to that challenge, expanding access to health care, behavioral health treatment and coordinated support services before individuals leave custody. The initiative, announced by County Executive Girmay Zahilay, is designed to reduce repeat incarceration, prevent interruptions in treatment and help people establish greater stability as they return to their families and communities.
The effort is part of Zahilay’s broader “Breaking the Cycle” strategy, which seeks to address the interconnected challenges of homelessness, addiction and repeated incarceration through expanded access to treatment and supportive services.
“Breaking the cycle of homelessness, addiction, and repeated incarceration requires meeting people where they are and providing them with the tools they need to rebuild their lives and reintegrate in community,” said Executive Zahilay. “By expanding access to healthcare and other supportive reentry services, King County is working to replace the revolving door of the criminal legal system with a stable bridge to recovery and rehabilitation – creating safer, healthier communities as a result.”
For people leaving jail, the challenges can extend far beyond incarceration itself. Accessing medications, reconnecting with health care providers and finding support for substance use or mental health conditions can be critical to maintaining stability during the first days and weeks after release.
CaSandra Adams, a peer adviser and peer specialist in community health who has personally experienced addiction and incarceration, understands how difficult that transition can be when people return to the community without reliable support.
“I know firsthand what it means to be trapped in the cycle of addiction and incarceration, released back into the community with nothing but the desire for something different and no solid ground to stand on. As someone who has lived that reality and found recovery, I know that wanting a different life isn’t always enough; people need access to care, connection, and tangible opportunities to change. This initiative has the potential to create those lifelines by bridging the gap between jail and community-based care, connecting people to treatment, medications for opiate use disorder, mental health services, primary care, and housing resources.”
Adams’ experience illustrates the challenges the initiative is intended to address. Rather than waiting until individuals leave jail to begin arranging treatment and other services, the county will work to establish those connections while they remain in custody.
Under the program, eligible adults can receive targeted health care and reentry services beginning as early as 90 days before release. The goal is to ensure that people who need medical treatment, medications or behavioral health services have a plan for continuing that care when they return to the community.
The initiative began operating this summer, with expanded services available in King County jails as of July 1.
The need for early coordination is particularly significant given the short amount of time many individuals spend in custody. According to King County, nearly 70% of adults held in county jails stay 10 days or less, and more than 90% are released within 90 days of booking.
That rapid turnover creates a narrow window for identifying health needs, beginning treatment and connecting people with community providers before discharge.
Through the initiative, eligible individuals can receive assistance determining their Medicaid eligibility and enrolling in coverage before leaving jail. This is intended to prevent gaps in insurance that could interrupt access to doctors, medications and ongoing treatment.
Participants can also receive individualized reentry case management, with plans connecting them to their Medicaid managed care organizations, community health clinics and behavioral health providers.
Additional services include substance use disorder evaluations, treatment and medications; prescribed medications for chronic illnesses and behavioral health conditions at release; and screening and treatment for infectious diseases, including hepatitis C.
These services are intended to address health concerns before they worsen and to help people continue treatment outside correctional facilities.
For individuals living with serious mental illness or substance use disorders, maintaining that continuity of care can be especially important.
Michelle Conley, director of integrated care at REACH, said the transition from incarceration to community-based treatment has historically exposed people to preventable interruptions in essential services.
“As an organization that believes reentry begins on day one of incarceration, we are grateful for King County’s leadership in advancing the Reentry Initiative. For too long, people living with serious mental illness and substance use disorder have faced preventable gaps in care during the transition from jail to the community, resulting in avoidable crises, overdoses, and deaths. From our perspective, this is fundamentally a disability rights issue and a community health imperative. It is in everyone’s best interest that people not lose access to lifesaving treatment, benefits, and support due to incarceration. By strengthening jail in-reach, care coordination, and continuity of services before and after release, this initiative moves us closer to a system that values recovery, dignity, and survival while creating safer, more resilient communities.”
The initiative also reflects a broader approach to public safety that emphasizes addressing health and behavioral health needs as part of efforts to reduce repeated involvement with the criminal legal system.
County officials believe that connecting people to treatment and community support before release could help reduce the circumstances that contribute to violations of release conditions and subsequent incarceration.
Steve Larsen, deputy director of the King County Department of Adult and Juvenile Detention, said the program will give correctional and health care staff more opportunities to develop coordinated plans before individuals return to the community.
“Too often, people come to jail and prisons in desperate need of stabilization for opioid use disorders. This program allows DAJD and our Jail Health partners to develop comprehensive plans and coordinated care inside correctional settings prior to someone’s return to the community. If they can be stabilized while incarcerated and handed off to a community partner, we’re likely to see fewer violations of their conditions of release and subsequent incarcerations. It is good for the person as well as the criminal legal system.”
The adult portion of the initiative is being led by Public Health — Seattle & King County’s Jail Health Services Division at the King County Correctional Facility in Seattle and the Maleng Regional Justice Center in Kent.
A related component at the Judge Patricia H. Clark Children and Family Justice Center in Seattle is being led by the Department of Adult and Juvenile Detention. That effort will allow youth in secure detention to maintain continuous Apple Health coverage, reducing the possibility of interruptions in health insurance during detention and reentry.
King County’s program is part of Washington’s statewide Reentry Demonstration Initiative, administered by the Washington State Health Care Authority with state and federal funding.
Washington was the second state in the nation to receive federal approval for a Medicaid reentry program and the second to begin implementation. More than 40 correctional facilities across the state are participating.
The funding structure is designed to help participating facilities build the capacity and technology needed to provide expanded services.
Under the initiative, each of King County’s two adult detention facilities is eligible for up to $1.5 million in capacity-building funding and $1 million for information technology infrastructure, representing up to $5 million combined across both facilities.
The adult facilities can also receive reimbursement for eligible Medicaid expenses during the initiative’s initial two-year period.
The county’s juvenile detention facility is eligible for up to $2 million through the youth component of the program.
Those amounts represent available funding, not necessarily money already spent. The investments are intended to support the systems and coordination required to connect individuals with health care services before they leave custody.
While research cited by the county indicates that effective reentry services can improve health outcomes, reduce repeat incarceration and lower costs, the long-term results of King County’s expanded initiative have yet to be established.
The county’s announcement did not include figures showing how many people have received assistance since the July 1 expansion or whether the program has reduced repeat incarceration.
For Adams, who has experienced the challenges of addiction, incarceration and recovery firsthand, the importance of connecting people with treatment and support is personal.
“That continuity of care can be the difference between returning to the cycle and finding a path to recovery; ultimately, it can be the difference between life and death.”
